1053643957 NPI number — QUALITY HOME HEALTH I LLC

Table of content: (NPI 1053643957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053643957 NPI number — QUALITY HOME HEALTH I LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY HOME HEALTH I LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053643957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 373
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELZONI
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39038-0373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-247-1254
Provider Business Mailing Address Fax Number:
662-247-4924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4242 HIGHWAY 1192
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARKSVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71351-4710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-253-5143
Provider Business Practice Location Address Fax Number:
662-247-4924
Provider Enumeration Date:
02/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
CLARA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
662-247-1254

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  2203781716 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2134779 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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